Prostate embolization (PAE) is a minimally invasive procedure in which an interventional radiologist places a catheter into the prostatic arteries and injects microscopic particles that block blood flow, resulting in prostate shrinkage and symptom relief.
What Is Prostate Embolization?
Prostate embolization is a treatment method for benign prostatic hyperplasia, which is commonly encountered in men. This minimally invasive procedure is performed by interventional radiology specialists. During the procedure, the doctor places micro particles into the arteries that supply blood to the prostate. These particles restrict blood flow, thereby helping to reduce the size of the prostate.
How Is Prostate Embolization Performed?
Before starting the prostate embolization procedure, a detailed map of the prostatic arteries is created, typically using MRI or CT angiography. This step is critical for the success of the procedure.
During the anesthesia phase, local anesthesia is generally applied to ensure patient comfort. This is performed through the groin area, where access to the femoral artery is obtained; access via the radial artery is also possible.
During catheter placement, a microcatheter is advanced from the femoral artery toward the prostatic arteries under fluoroscopic guidance.
An angiography is then performed to precisely determine the locations of the arteries supplying blood to the prostate.
During the embolization process, particles such as polyvinyl alcohol or microspheres are injected into the prostatic arteries. These particles block the arteries, stopping blood flow to the prostate and causing the tissue to shrink.
After the procedure, the patient is observed for a short period and is usually discharged on the same day. Follow‑up visits are scheduled to monitor changes in prostate size and symptom improvement.
Who Is a Candidate for Prostate Embolization?
Prostatic artery embolization is suitable for certain men. This method is especially recommended for those exhibiting symptoms of benign prostatic enlargement who do not respond adequately to standard medical treatments. Candidates typically have severe lower urinary tract symptoms, including frequent urination, sudden urgency, and weak urine stream.
- Severe Lower Urinary Tract Symptoms (LUTS): Individuals experiencing significant urinary symptoms unresponsive to medications.
- Enlarged Prostate: Patients with a prostate volume of 50 mL or more.
- Failure of Medical Treatment: Those who do not show improvement with standard medical treatments (alpha blockers and 5-alpha reductase inhibitors).
- Surgical Contraindications: Patients with high surgical risk or significant comorbidities.
- Patient Preference: Those who prefer a minimally invasive procedure due to lower complication risks and faster recovery.
- Avoidance of General Anesthesia: Suitable for patients for whom procedures requiring general anesthesia are not appropriate.
What Should Be Considered Before Prostate Embolization?
Pre‑procedural considerations are critical for the success of prostate embolization. Patient evaluation begins with a careful review of medical history and current medications, especially those affecting blood clotting and cardiovascular health. The patient’s symptoms are assessed using the International Prostate Symptom Score, which determines the severity of symptoms and responsiveness to medical treatment.
Imaging and diagnostic tests include:
- MRI: if there is a suspicion of prostate cancer
- CT Angiography: if there is suspected blockage in the pelvic vasculature
Prostate-specific antigen testing is performed to rule out active malignancy that would contraindicate PAE. Prophylactic antibiotics are administered pre‑procedure to reduce infection risk. Additionally, non‑steroidal anti‑inflammatory drugs are used post‑procedure to manage pain and inflammation.
The informed consent process educates patients about possible complications and sets realistic expectations for recovery, informing them that symptom improvement may take time.
Screening for contraindications includes:
- Assessment of kidney function, which is important for contrast dye usage.
- Allergy screening for the contrast agents to be used.
What Are the Differences Between Prostate Embolization and Surgical Prostatectomy?
Prostatic artery embolization is a minimally invasive procedure performed within the field of interventional radiology. In this method, microscopic particles are injected into the arteries that supply the prostate, reducing blood flow and shrinking the prostate. Patients are typically able to return home on the same day and resume normal activities within a few days.
Invasiveness and Procedure Type:
- PAE is minimally invasive; no surgical incisions are required.
- TURP is a more invasive surgical procedure performed through the urethra.
Recovery and Hospital Stay:
- PAE is generally performed on an outpatient basis.
- TURP requires a hospital stay of one to three days.
Efficacy:
- PAE provides symptom relief, though it may be less effective than TURP.
- TURP offers greater improvements in urinary flow and prostate size reduction.
What Are the Side Effects of Prostate Embolization?
The potential side effects and complications of prostatic artery embolization are important for patients to consider. Some common issues that may occur after the procedure include:
Post‑Embolization Syndrome:
- Pelvic pain and low‑grade fever
- Nausea and vomiting
- General fatigue
These symptoms usually resolve within a few days to a week, and patients are advised to rest during this period.
Urinary Issues:
- Increased frequency of urination
- Sudden, painful urge to urinate
- Difficulty urinating
These urinary issues are typically temporary and resolve over time.
Inflammatory Reactions:
- Inflammation in the prostate and surrounding tissues
- Development of prostatitis or urethritis
Such inflammation is generally treated with anti‑inflammatory medications and antibiotics.
Non‑Target Embolization Risk:
- Ischemia of the rectum, bladder, or penis
- Rectal pain and hematuria
- Penile pain or discoloration
These complications occur when non‑target tissues are inadvertently affected during embolization.
Sexual Dysfunction:
- Erectile dysfunction
- Reduced ejaculatory volume
These issues are generally temporary, though in some cases they may be permanent.
Bleeding and Hematoma Formation:
- Bleeding at the puncture site
- Hematoma development
These problems are rare and are managed with proper post‑procedure care.
Ischemic Complications:
- Ischemic damage to the prostate tissue
- Risk of necrosis and abscess formation
How Are Sexual Functions Affected After Prostate Embolization?
The effects of prostatic artery embolization on sexual function are varied. Notable outcomes have been observed in erectile and ejaculatory functions.
Erectile Function:
- Various studies have examined the effect of prostate embolization on erectile function, with generally mixed results.
- Some patients experience stabilization or improvement in erectile function. The recovery process is gradual, and scores measured by the International Index of Erectile Function usually remain stable or show slight improvement within the first year post‑treatment.
- Some reports indicate that prostate embolization does not adversely affect erectile function; however, results may vary based on the patient’s age and overall health.
Ejaculatory Function:
- The effects on ejaculatory function are more pronounced and are often negative.
- Reduced ejaculation is observed in about 40 % of cases.
- Abolition of ejaculation occurs in approximately 10–16 % of patients.
- These disturbances result from fibrosis and necrosis in structures controlling ejaculation due to the injected particles.
Compared to other treatments such as transurethral resection of the prostate (TURP), prostatic artery embolization tends to be less harmful to ejaculatory function. Nevertheless, ejaculatory disorders remain among the most significant adverse effects of the treatment.
Does Prostate Embolization Cause Post‑Procedure Pain and Discomfort?
Post‑embolization pain and discomfort are common following prostatic artery embolization. This condition, known as post‑embolization syndrome, encompasses various symptoms. Patients typically experience the following:
- Mild fever
- Fatigue
- Nausea
- Localized pain
- Burning sensation during urination
These symptoms result from the blockage of blood vessels in the prostate by the microscopic particles. The pain is often associated with the activation of visceral nociceptors and may be perceived as a burning sensation. These discomforts are particularly prominent in the first few days after the procedure; approximately 25.5 % of patients experience such symptoms. To manage pain and other side effects, patients are typically prescribed:
- NSAIDs
- Steroids, when necessary
What Is the Success Rate of Prostate Embolization?
Prostatic artery embolization shows variable success rates over time. In the early period, the success of this treatment is quite high. The success rates achieved within the first year are generally around 88 %. Depending on the study, these rates vary between 77 % and 92 %.
Short‑term success (1‑12 months): Average 88.1 %
- Minimum: 77.6 %
- Maximum: 92.4 %
In the medium‑term, the success rate decreases slightly but remains promising. In studies covering 2 to 5 years, the success rate is approximately 85 % on average.
Medium‑term success (2‑5 years): Average 85.1 %
- Minimum: 71.3 %
- Maximum: 93.1 %
Over the long term (6‑10 years), the success rate falls to about 76 % on average, with rates varying between 69 % and 84.6 %.
Long‑term success (6‑10 years): Average 76.8 %
- Minimum: 69.1 %
- Maximum: 84.6 %
What Is the Post‑Procedure Recovery Process After Prostate Embolization?
The recovery process after prostate embolization involves several stages and is generally well tolerated by patients. Most patients can go home immediately after the procedure since it is usually performed on an outpatient basis. In the first days following the procedure, patients must adhere to certain restrictions, especially avoiding heavy lifting or strenuous physical activities that could traumatize the treated area.
During the first week, patients may experience low‑grade fever and mild pelvic cramps, which typically resolve within a week. A follow‑up appointment is scheduled within the first week to assess recovery.
In the medium term, as the prostate reshapes, complete symptomatic improvement may take three to six months. Some patients may experience temporary complications such as urinary retention or urinary tract infections, which are generally managed appropriately.
During long‑term follow‑up, recovery is evaluated at regular intervals. The effectiveness and sustainability of recovery are monitored using the International Prostate Symptom Score and, if needed, other tests. This phase is typically supported by scheduled visits at 1, 3, 6, and 12 months.
How Long Does It Take to Return to Daily Life After Prostate Embolization?
The recovery process after prostate embolization allows patients to return to their daily lives quickly. Most patients resume normal activities within one to two days after the procedure, which is possible due to the outpatient nature of the treatment and the absence of general anesthesia.
Most patients can go home the same day.
It is advised to avoid strenuous activities for the first few days.
Mild side effects may be experienced during recovery:
- Nausea
- Frequent or painful urination
- Mild fever
- Pelvic pain
These side effects generally resolve within a few days. Special attention should be given to the healing of the puncture site.
Do Urinary Problems Improve After Prostate Embolization?
Improvements in urinary symptoms after prostate embolization have been documented in several studies. Patients experience a significant reduction in urinary symptoms post‑procedure, as measured by a decrease in the International Prostate Symptom Score. Improvement typically begins shortly after the procedure and continues during long‑term follow‑up.
Symptom Improvement:
- Average IPSS scores decrease from high to low levels.
- The reduction in symptoms remains stable for six years or more.
Quality of Life:
- Significant improvements in quality of life have been reported.
- Most patients are satisfied with their urinary function one year after the procedure.
Long‑Term Effectiveness:
- Continuous symptom relief and improved urinary function have been observed over a ten‑year period.
- Prostate volume and pressure on the urethra are reduced.
Safety Profile:
- The safety profile of PAE is considered better compared to surgical interventions.
- Complications are generally mild and self‑limiting.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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